Provider Demographics
NPI:1053325571
Name:MORENO, MADELEINE RACHELLE (MSN, PMHNP- BC (CRNP)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:RACHELLE
Last Name:MORENO
Suffix:
Gender:F
Credentials:MSN, PMHNP- BC (CRNP
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, PMHNP- BC
Mailing Address - Street 1:PO BOX 870360
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35487-5309
Mailing Address - Country:US
Mailing Address - Phone:205-348-6262
Mailing Address - Fax:
Practice Address - Street 1:750 PETER BRYCE BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7456
Practice Address - Country:US
Practice Address - Phone:205-348-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-0527712084B0040X
AL10527712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry